Bariatric surgery decision-making of adults with obesity: a grounded theory study

Abstract

Objective: The retention rate of Bariatric Surgery (BS) remains a critical concern, yet the decision-making mechanism among obese individuals considering BS is still unclear. This study aims to identify key stages and core mechanisms in the BS decision-making process. Design: Qualitative, one-on-one, and focus group in-depth interviews were conducted. Methods: Semi-structured interviews were conducted in China from September 2022 to February 2023. Using the Straussian Grounded Theory (SGT) approach, an iterative analysis of the BS decision-making process was performed, ultimately constructing a decision-making mechanism for obese patients opting for BS. Reporting followed the SRQR checklist. Results: Interviews were conducted with 21 obese individuals scheduled for BS one day before surgery. A theoretical model was developed to describe and explain the BS decision-making process. The study identified five key stages in the decision-making process: Initial Attention, Proactive Information-Seeking, Decision-Making Process, Definitive Surgical Decision, Preparation Phase, and Abandonment, with the Decision-Making Process being the most critical. The study examined the influence of External Environment on Cognitive Decision-Making, focusing on social pressure, social support, and peer support. Additionally, the Cognitive Trade-off Theory for Bariatric Surgery (CTT-BS) was established, incorporating five cognitive-level factors. Conclusion: The identified decision-making stages and cognitive theory provide evidence to clarify the facilitators and barriers to BS motivation retention, offering insights for developing strategies to improve BS retention rates.